Provider Demographics
NPI:1679564694
Name:MILES, CAROL SHAVER (MA, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:SHAVER
Last Name:MILES
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 288
Mailing Address - Street 2:37776 OLD HIGHWAY ROAD
Mailing Address - City:QUINCY
Mailing Address - State:CA
Mailing Address - Zip Code:95971-0288
Mailing Address - Country:US
Mailing Address - Phone:530-281-6606
Mailing Address - Fax:
Practice Address - Street 1:355 MAIN ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:CA
Practice Address - Zip Code:95971-9121
Practice Address - Country:US
Practice Address - Phone:530-394-7706
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASP6324235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist